Anxiety and Depression Together?
BY R. Morgan Griffin
October 20 2010 5:00 AM ET
Different experts take different approaches to treating depression with anxiety. Some try to work out which condition is causing the major problems -- the primary condition -- and try to resolve that first. Others try to deal with both at the same time. Fortunately, many treatments are good for either individual condition. They just might be used in different ways.
Here's a rundown of five ways to treat depression and anxiety:
(1) Antidepressants. Despite the name, these drugs aren't just for depression anymore. "We've learned that a lot of the medications originally approved as antidepressants also relieve anxiety symptoms," says David I. Sommers, Ph.D., the scientific review officer at the National Institute of Mental Health in Bethesda, Md. However, it's key that you get the right medication. Some antidepressants have a reputation for being activating, which could worsen anxiety symptoms.
For depression and anxiety, many doctors first turn to an SSRI antidepressant -- like Lexapro, Paxil, and Zoloft. "I think they're some of the safest and easiest to use," MacKinnon says. Cymbalta and Effexor -- newer antidepressants known as SNRIs -- are other first-line anxiety and depression treatments. If those medications don't work, your doctor may try other antidepressants like the older tricyclic medications.
(2) Therapy. Although many types of talk therapy may help, the approach with the best evidence for depression and anxiety is cognitive behavioral therapy. CBT is a technique that helps people identify and then change the thought and behavior patterns that add to their distress. "When you're anxious and depressed, you've come to believe that the world is a much more negative and frightening place than it is," MacKinnon says. "CBT helps expose those ways of thinking and teaches you ways to develop new ones."
(3) Antianxiety medicines. Although some antidepressants can help both depression and anxiety, they take some time to work. Other drugs like benzodiazepines -- Ativan or Xanax, for example -- can quickly control the symptoms of anxiety. However, many doctors are reluctant to prescribe them in the long term because of a potential risk of abuse or addiction.
(4) Other medications. Depending on how a person responds to treatment, other medications might help. MacKinnon says that some people with depression and anxiety benefit from mood stabilizers like lithium, antipsychotic drugs, and antiepileptic drugs on top of their antidepressants. Medications that help with sleep - like the antidepressant trazodone - may allow people with anxiety to get the rest they need.
(5) Lifestyle changes. Experts stress that you can do a lot to support your treatment for depression and anxiety. Try to eat well and get enough sleep. Don't rely on alcohol or illicit drugs. Physical activity is key, since there's good evidence that it can help with mood and may help people bounce back from depression. Breathing exercises, muscle relaxation, and disciplines like yoga can help too.
"Most people already know this stuff," Sommers says. "Telling people that eating well or exercising is a good idea is often just preaching to the choir." The key, he says, is to figure out ways of integrating better habits into your life. That's something else that you can work on with your therapist.
Which approach is best to treat depression and anxiety symptoms? There's no right answer; it all depends on the person. Sometimes, just one approach -- like therapy or an antidepressant -- is enough. In some people, it isn't.
"There's evidence that people who have both depression and anxiety tend not to do as well with just the standard treatments," Cook says. "They may need more aggressive treatment at the outset, with more frequent appointments and closer monitoring." People with depression and anxiety might do best with a combination of therapy and medication, he says, or a pairing of different medications at the same time.